BIOCERAMIC ENDODONTIC SEALERS: A STRUCTURED NARRATIVE REVIEW OF PHYSICOCHEMICAL PROPERTIES, BIOLOGICAL BEHAVIOR, CLINICAL OUTCOMES, AND LIMITATIONS
DOI:
https://doi.org/10.31435/ijitss.4(52).2026.6330Keywords:
Bioceramic Sealer, Calcium Silicate-Based Sealer, Root Canal Obturation, Endodontic Sealer, Single-Cone ObturationAbstract
Bioceramic endodontic sealers have become increasingly important in contemporary root canal obturation because of their hydraulic setting, hydrophilicity, alkaline pH, calcium ion release, bioactivity, and potential interaction with dentin and periapical tissues. The aim of this structured narrative literature review was to evaluate current evidence regarding bioceramic endodontic sealers, with emphasis on their composition, physicochemical properties, biological behavior, sealing ability, obturation techniques, clinical outcomes, postoperative pain, retreatability, and limitations. A literature search was performed using PubMed, PubMed Central, and Europe PMC, focusing on English-language full-text articles published between 2022 and 2026. The reviewed literature suggests that calcium silicate-based sealers demonstrate favorable laboratory properties, including dentinal tubule penetration, calcium ion release, high alkalinity, apatite-forming ability, and acceptable cytocompatibility. However, these properties vary between commercial products and should not be generalized to the entire material class. Clinical studies indicate that bioceramic sealers can achieve outcomes comparable to traditional epoxy resin- and zinc oxide-eugenol-based sealers, particularly when used with single-cone or sealer-based obturation techniques. Current evidence supports bioceramic sealers as clinically viable alternatives rather than universally superior replacements. Further long-term clinical studies are needed to clarify product-specific performance, retreatability, extrusion behavior, and long-term treatment outcomes.
References
Zamparini, F., Lenzi, J., Duncan, H. F., Spinelli, A., Gandolfi, M. G., & Prati, C. (2024). The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post-obturation pain: A systematic review and meta-analysis. Int Endod J, 57(8), 1021–1042. https://doi.org/10.1111/iej.14069
Ashkar, I., Sanz, J. L., Forner, L., & Melo, M. (2023). Calcium silicate-based sealer dentinal tubule penetration-A systematic review of in vitro studies. Materials (Basel), 16(7), 2734. https://doi.org/10.3390/ma16072734
Mora, A., García-Bernal, D., Rodríguez-Lozano, F. J., Sanz, J. L., Forner, L., Ghilotti, J., Lozano, A., & López-García, S. (2024). Biocompatibility, bioactivity and immunomodulatory properties of three calcium silicate-based sealers: An in vitro study on hPDLSCs. Clin Oral Investig, 28(8), 416. https://doi.org/10.1007/s00784-024-05812-1
Radwanski, M., Rozpedek-Kaminska, W., Galita, G., Siwecka, N., Sokolowski, J., Majsterek, I., Özcan, M., & Lukomska-Szymanska, M. (2024). Cytotoxicity and genotoxicity of bioceramic root canal sealers compared to conventional resin-based sealer. Sci Rep, 14(1), 4124. https://doi.org/10.1038/s41598-024-54726-1
Wang, Y., Tang, M., Yang, X., & Yang, J. (2025). Evaluating the penetration, interfacial adaptation, and push-out bond strength of four bioceramic-based root canal sealers. BMC Oral Health, 25(1), 748. https://doi.org/10.1186/s12903-025-06124-w
Mansour, M. M., Moussa, S. M., Meheissen, M. A., & Aboelseoud, M. R. (2024). Bacterial sealing ability of calcium silicate-based sealer for endodontic surgery: An in-vitro study. BMC Oral Health, 24(1), 584. https://doi.org/10.1186/s12903-024-04309-3
Gharechahi, M., Hoseinzadeh, M., Moradi, S., & Mehrjouei, M. (2024). Evaluation of various obturation techniques with bioceramic sealers in 3D-printed C-shaped canals. BMC Oral Health, 24(1), 554. https://doi.org/10.1186/s12903-024-04334-2
Wang, Y. H., Liu, S. Y., & Dong, Y. M. (2024). In vitro evaluation of the impact of a bioceramic root canal sealer on the mechanical properties of tooth roots. J Dent Sci, 19(3), 1734–1740. https://doi.org/10.1016/j.jds.2023.10.013
Kim, J. H., Cho, S. Y., Choi, Y., Kim, D. H., Shin, S. J., & Jung, I. Y. (2022). Clinical efficacy of sealer-based obturation using calcium silicate sealers: A randomized clinical trial. J Endod, 48(2), 144–151. https://doi.org/10.1016/j.joen.2021.11.011
Seog, M., Kwon, S. K., Kim, D., Shin, S. J., & Jung, I. Y. (2025). Five-year outcomes of root canal treatment comparing sealer-based obturation with calcium silicate-based sealer to continuous wave of condensation: A randomized controlled trial. J Endod, 51(5), 538–546. https://doi.org/10.1016/j.joen.2025.02.001
Singhal, R., Singla, M. G., Wahi, P., Bhasin, P., Garg, A., & Nangia, D. (2025). Sealing ability of three bioceramic sealers using sealer-based obturation method after immersion in simulated body fluid. J Conserv Dent Endod, 28(2), 199–203. https://doi.org/10.4103/JCDE.JCDE_605_24
Drukteinis, S., Bilvinaite, G., & Sakirzanovas, S. (2024). The impact of citric acid solution on hydraulic calcium silicate-based sealers and root dentin: A preliminary assessment. Materials (Basel), 17(6), 1351. https://doi.org/10.3390/ma17061351
Hamdy, T. M., Galal, M. M., Ismail, A. G., & Saber, S. (2024). Physicochemical properties of AH plus bioceramic sealer, Bio-C Sealer, and ADseal root canal sealer. Head Face Med, 20(1), 2. https://doi.org/10.1186/s13005-023-00403-z
Krug, R., Schwarz, F., Hahn, B., Reymus, M., Eggmann, F., Krastl, G., & Soliman, S. (2025). Long-term tooth discoloration induced by apical plugs with hydraulic calcium silicate-based cements in bovine teeth with open apices - a 6-year in-vitro study. Clin Oral Investig, 29(6), 332. https://doi.org/10.1007/s00784-025-06407-0
Patthanawijit, L., Yanpiset, K., Saikaew, P., & Jantarat, J. (2024). Fiber post cemented using different adhesive strategies to root canal dentin obturated with calcium silicate-based sealer. BMC Oral Health, 24(1), 1290. https://doi.org/10.1186/s12903-024-04963-7
Govindaraju, L., Kalaiselvam, R., Rajendran, M. R., Jakovljevic, A., Jacomovic, J., Duncan, H. F., & Nagendrababu, V. (2026). Does the use of a bioceramic sealer reduce postoperative pain compared with an epoxy resin-based sealer after primary root canal treatment and retreatment?-An umbrella review. Int Endod J, 59(3), 341–350. Erratum in Int Endod J (2026, February 23): https://doi.org/10.1111/iej.70127; https://doi.org/10.1111/iej.70073
Verma, A., Arora, A., & Taneja, S. (2024). Comparative evaluation of dentinal tubule penetration and push-out bond strength of new injectable hydraulic calcium disilicate based root canal sealer: A single blinded in vitro study. J Oral Biol Craniofac Res, 14(2), 143–151. https://doi.org/10.1016/j.jobcr.2024.01.009
Nagpal, R., Taneja, S., & Bhalla, V. K. (2024). The effect of bioactive glass-based, bioceramic based and epoxy amine resin based root canal sealers on post-obturation pain: A double blinded randomized controlled trial. J Conserv Dent Endod, 27(6), 591–597. https://doi.org/10.4103/JCDE.JCDE_115_24
Kashaf, A., Alonaizan, F., Almulhim, K. S., Almohazey, D., Alotaibi, D. A., Akhtar, S., Shetty, A. C., & Khan, A. S. (2024). An in vitro comparative analysis of physico-mechanical properties of commercial and experimental bioactive endodontic sealers. Bioengineering (Basel), 11(11), 1079. https://doi.org/10.3390/bioengineering11111079
Rane, S., Pandit, V., Sachdev, S. S., Chauhan, S., Mistry, R., & Kumar, B. (2024). Comparative evaluation of apical leakage in root canal obturation using AH Plus Sealer, bioceramic sealer, and bioceramic sealer incorporated with chitosan nanoparticles: An in vitro study. Cureus, 16(12), e75359. https://doi.org/10.7759/cureus.75359
Bardini, G., Bellido, M. M., Rossi-Fedele, G., Casula, L., Dettori, C., Ideo, F., & Cotti, E. (2025). A 4-year follow-up of root canal obturation using a calcium silicate-based sealer and a zinc oxide-eugenol sealer: A randomized clinical trial. Int Endod J, 58(2), 193–208. https://doi.org/10.1111/iej.14167
Spinelli, A., Zamparini, F., Lenzi, J., Gandolfi, M. G., & Prati, C. (2024). Three-year clinical outcome of root canal treatment using a single-cone technique and Ceraseal premixed bioceramic sealer: A prospective cohort study. Eur Endod J, 9(4), 383–393. https://doi.org/10.14744/eej.2024.75537
Ortega, M. A., Rios, L., Fraile-Martinez, O., Liviu Boaru, D., De Leon-Oliva, D., Barrena-Blázquez, S., Pereda-Cerquella, C., Garrido-Gil, M. J., Manteca, L., Buján, J., García-Honduvilla, N., García-Montero, C., & Rios-Parra, A. (2024). Bioceramic versus traditional biomaterials for endodontic sealers according to the ideal properties. Histol Histopathol, 39(3), 279–292. https://doi.org/10.14670/HH-18-664
Prasad Kumara, P. A. A. S., Cooper, P. R., Cathro, P., Gould, M., Dias, G., & Ratnayake, J. (2025). Bioceramics in endodontics: Limitations and future innovations-A review. Dent J (Basel), 13(4), 157. https://doi.org/10.3390/dj13040157
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Jakub Sagan, Michał Zemowski, Małgorzata Berowska, Gabriela Pilch, Agnieszka Ciepiela, Zuzanna Kucia

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

